800-400 B.C.: Greeks define tracheotomy

Knowledge of mouth to mouth breathing and the surgical procedure of tracheotomy would have made it's way from ancient Egypt to ancient Greece. There were many Greek philosophers who studied medicine at one of Egypts fine schools, probably at Heliopolis early on and Alexandria later. The procedure more than likely made it's way to Greece by this means. 

So this knowledge must have appeared via a dream to a priest at the Asclepion at Cos, who must have used it successfully at some point early in Greek's history. Details of the procedure and the diagnosis it was used for would have been surreptitiously etched onto a stone slab that was kept at the temple for future reference. The slabs may also have been used as early medical texts, as such temples also served as schools. 

Sometime around 450 B.C. a boy by the name of Hippocrates (460-370 B.C.) sat with his father, a physician, at the temple, learning as much as he could about medicine, perhaps using the stone slabs as texts. Hippocrates grew to become the greatest physician of the ancient world, and would become the first to write about the procedure in his Hippocratic Corpuus.  He wrote:

"A tube should be inserted into the throat, along the jaws, so that the air may be attracted to the lungs."  (1) 

The procedure is perhaps best detailed by historian Pierre Victor Renouard in his 1867 history of medicine:

When the air passage is stopped by any obstacle, the anguish is extreme, the suffocation iminent, and the patient speedily dies, unless promptly succored. This accident has sometimes occurred in a violent quinsey, but more frequently in the fibrinous effusion in children, called croup. The Hippocratic works indicate as the only resource in this extremity, to pass a leek leaf, or any elastic tube, into the throat of the patient; but this agent is very diflicult of application, and I doubt whether it was ever done advantageously.(2, pages 448-449)

The ancient Greeks would have referred to this procedure as a tracheotomy.  The term, according to dictionary.com, comes from a combination of the Greek terms for "windpipe" (arterios trakheia) and "to cut into" (tom).  It means to cut into the trachea.

Another term, tracheostomy, comes from the combination of the Greek terms for "windpipe" (arterios trakheia) and "mouth, opening, or orifice" (stoma).  It is the creation of an opening in the trachea.  The opening is often referred to as a stoma, which comes from the Greek term for mouth, opening, orifice.  It is the opening created in the trachea or, simply, the hole in the trachea.

However, it should be understood here that, according to Dr. Morrell Mackenzie in his 1880 book "Disease of the nose and throat," the term tracheotomy was first used by Lorenz Heister (1683-1758).  Prior to him the procedure was actually called a bronchotomy.  Mackenzie defined bronchotomy as "the various operations by which the air-passages are laid open."  (3, pages 520,522)

For simplicities sake, I will simply refer to the procedure as a tracheotomy for the purposes of this history.

So while the ancient Greeks definitely didn't invent the procedure, they gave it a name and an identity.

References:

1. Fourgeaud, V.J, "Medicine Among the Arabs," (Historical Sketches), Pacific medical and surgical journal, Vol. VII, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Fransisco, Thompson & Company, pages 193-203 (referenced to page 198-9) 
2. Lee, W.L., A.S. Stutsky, "Ventilator-induced lung injury and recommendations for mechanical ventilation of patients with ARDS," Semin. Respit. Critical Care Medicine, 2001, June, 22, 3, pages 269-280 
3. Mackenzie, Morrell, "Diseases of the throat and nose, Volume I, 1880, Philadelphia, Presley Blakiston

RT Cave Facebook Page
RT Cave on Twitter

124 B.C.: The Methodist school of medicine

Over time a third school, or sect, of medicine evolved that gained popularity in ancient Greece and Rome and had a significant affect on the remedies provided to patients. In fact, it was by following the opinions of this school that helped one famous physicians convince the Romans to accept Greek medicine, an import event allowing medicine to advance forward through time.

Like Empiricism, Methodism was a school, or sect, that evolved out of the skeptics of ancient Greece, this time through the works of Anaxagoras of Clazamenae (500-428 B.C.), Archelaos of Athens (born about 500 B.C.), Democritus (460-370 B.C.), and Zeno (490-430 B.C.).

The motto of this school went something like this:

A pathological theory we must have, but let it be simple."  (8, page xiv)

It is believed to be started with Anaxagoras of Clazomenae (50-428 B.C.), who preached that there was a distinction between mind and body. (5, page 15)

It also might have started with Parmenides of Elea (born about 540 B.C.?), who...

...argued that it is impossible for there to be change without something coming from nothing. Since the idea that something could come from nothing was generally agreed to be impossible, Parmenides argued that change is merely illusory. (10)

Archelaos of Athens (born about 500 B.C.?) was a pupil of Anaxagoras who added to his master's ideas the "fundamental principle of air."  Diogenes of Apollonia (lived around 420 B.C.?) made "air endowed with reason the origin of bodily and mental life. "  (9, page 110)

Zeno of Elea was not as purely skeptical as Pyrrho was.  Historian Norman Maccoll said, in his 1868 book, that Zeno "was in reality a dogmatist, and sceptical only to the overthrow of what opposed his own speculations." (11, page 17)

While none of Zeno's writings has survived, he is credited with writing what have become known as Zeno's paradoxes.  While none of his original paradoxes have survived, passages from other authors are thought to be direct quotations from them.  (12, page 6)

Zeno, of whom little is known, was a disciple of Parmenides (born 515 B.C.?), who "maintained that reality is one, immutable, and unchanging; all plurality, change, and motion are mere illusions of the senses," said Wesley C. Salmon, editor of the 1970 book "Zeno's Paradoxes." (12, page 6)

Salmon said "Zeno, according to Plato's testimony, propounded a series of arguments designed to show the absurdity of the views of those who made fun of Parmenides.  Zeno was not a "skeptic who denied the possibility of all knowledge." (12, page 6)

Around 450 B.C., Democritus (460-370 B.C.), who was a contemporary, although about 40 or 50 years younger, of Anaxagoras, "acknowledged the distinction, and describing both mind and body as composed of atoms or corpuscles, differing only in their nature and arrangement." (5, page 15)(9, page 109) (10)

Because he believed the body was composed of atoms he was referred to as an atomist.  The school that ultimately formed based on his ideas was called the atomist school, although later scholars referred to it as the methodist school.

Still others referred to it as the solidist school because of the belief that diseases were formed by the solid living forms of the body as compared to fluids or humors of Hippocrates.  .

The teacher of Democritus was Leucippus, and very little is known of him. It is believed that Democritus reorganized his teachers works, and then formed the anatomist theory. 10)

Sylvia Berryman, who wrote about Democritus in the 2010 Stanford Encyclopedia of Philosophy, said:

Ancient sources describe atoms  as one of a number of attempts by early Greek natural philosophers to respond to the challenge offered by Parmenides... In response, Leucippus and Democritus, along with other Presocratic pluralists such as Empedocles and Anaxagoras, developed systems that made change possible by showing that it does not require that something should come to be from nothing. These responses to Parmenides suppose that there are multiple unchanging material principles, which persist and merely rearrange themselves to form the changing world of appearances. In the atomist version, these unchanging material principles are indivisible particles, the atoms: the atomists are said to have taken the idea that there is a lower limit to divisibility to answer Zeno's paradoxes about the impossibility of traversing infinitely divisible magnitudes. (10)

Berryman explained that Democritus wrote about a world that was composed of atoms and voids.  The atoms were of varying sizes and shapes, and they were perfectly solid and, aside from changing location, were unchangeable or indestructible. Each atom also had a hook to allow it to attach to other atoms.

The atoms moved about in the void, often colliding with one another, and often becoming attached by their hooks to form clusters of varying shapes, sizes and colors that were the various objects (kosmoi)of the world, such as humans, animals, and trees. (10)

After a period of time the atoms relocate, change location through the voids, and attach to other atoms to form new kosmoi.  This process is ongoing for eternity. (10) 

Zeno of Elea collected the works of Democritus, along with the works of Anaxagoras, Parmenides, Plato, and Socrates, "which countenanced his distrust of sense knowledge." said Maccoll (11, pages 34-35)

Many of the principles of the school were established by Cleophantus of Alexandria and taught to his followers in creating a new school.  One of his students was Asclepiades. (3, page 92)

In the first century A.D. Asclepiades was an Atomist who made many "innovations" to this school, although he was originally considered a rationalist. (3, page 110)

He ultimately opposed the Hippocratic doctrines, supported the atomist hypothesis of Democritus, and added to it the the doctrine of "Strictum et Laxum" which states that disease is caused by excessive relaxation and tension of its solid particles, hence the term "solidism".  The school became known as the solidist school of medicine.  (7, page 73)

The desciple of Asclepiades was Themison of Laodicea.  Both of these physicians are often credited with forming the Methodist School of Medicine, which competed with the rational and empirical schools of medicine. (5, page 39-40)

Unlike the rationalists, they didn't try to find causes of disease. Unlike the empiricals, they didn't try to treat diseases based on their symptoms. Instead, "Themison declared that the physician should observe what symptoms various diseases have in common. He would then find that in all, or nearly all cases, there was an increase or dimunition of the secretions and extretions, and adapting this to the theory of Asclepiades, Themison argued that all diseases were due to a relaxation or a constriction of the 'pores.'" (2, page 85-6)

However, like the rationalist they believed "that the physician might reason from the seen to the unseen, e.g., from the state of the secretions to that of the pores."  From the empirics they "taught that diseases are to be judged from their symptoms, and not from their causes." They also agreed with the emperics that knowledge of anatomy irrelevent to treating diseases, "though it might be useful to know the names of the parts."  (2, page 86)

So the location of the disease was not important.  What organ caused a disease was not important.  The reason is that they considered a disease to be a general ailment of the body.  The cause wasn't important either, because they all either cause relaxation or constriction.  In other words, they believed that "constriction and relaxation are the same wherever they occur and require the same treatment." (2, page 86)

Medical historian John Brock describes it this way:

They held that molecular groups constituting the tissues were traversed by minute channels (pores); all diseases belonged to one or other of two classes; if the channels were constricted the disease was one of stasis, and if they were dilated the disease was one of flux. Flux and stasis were indicated respectively by increase and diminution of the natural secretions; treatment was the opposite by opposites -- of stasis by methods causing dilation of the channels, and conversely. (8, page xiv-xv)

Followers of this school treated diseases based on what was in the past effective in treating that disease, as opposed to treating patients based on speculation and superstition. "Their remedies were naturally divided into relaxants and astringents... They inculcated the use of gymnastic exercises, not only as remedial agents, but also as a means of counteracting the bad effects of increasing luxury and indolence." (5, page 41)

Astringent remedies used were "cold air and water, vinegar, decoctions of various herbs, especially the plantain, and the minerals, alum, lead and chalk, which were used externally.  The laxitive remdedy used most often was bleeding by venesection, cupping or leeches.  They did not use purgatives.  (2, page 86)

Their remedies tended to be gentler than dogmatic remedies, and perhaps for this is the reason Asclepiades was successful changing the Roman opinion of Greek medicine.

According to Brock "the vice of the Methodist teaching was that it looked on a disease too much as something fixed and finite, an independent entity, to be considered entirely apart from its particular setting."

Regardless of it's flaws, this school provided another option for physicians to follow and learn from, and some of the knowledge obtained later benefited the medical community in general.

References:

1. "Rationalism (philosophy), Encyclopedia Britannica.com, http://www.britannica.com/EBchecked/topic/492034/rationalism
2. Withington, Edward Theodore, "Medical History from the Earliest Times," 1894, London 
3. Watson, John, "Medical Profession in Ancient Times," 1856, New York, Baker and Godwin 
4. Magill, Frank N., editor, "Dictionary of World Biography," Volume I: The Ancient World, 1998, Salem Press Inc., California 
5. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861, 
6. Adams, Charles, Kendall, editor, "Johnson's Universal Cyclopedia: A new edition," volume V, A. Johnson Company, New York, 1894 
7. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company 
8. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
9. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
10. Berryman, Sylvia, "Democritus," from the book "The Stanford Encyclopedia of Philosophy," http://plato.stanford.edu/entries/democritus/, 2010, accessed 12/22/13
11. Maccoll, Norman, "The Greek Skeptics from Pyrrho to Sextus: An Essay which obtained the Hare Prize in the Year 1868," 1868, London and Cambridge, Macmillan and Co.
12. Wesley C. Salmon, editor and author of Introduction,  "Zeno's Paradoxes," edited by Wesley C. Salmon, 1970, Bobbs-Merrill Company, Inc. 

RT Cave Facebook Page
RT Cave on Twitter

331 B.C- 619 A.D..: The School of Alexandria

Figure 1 --Alexander the Great had a vision of creating
a great city, and compiling all the science and wisdom of
the world in one place.  He died before he was 32, thus
not living to see his dream come true. 

The evolution of medicine was slow moving through most of history.  One of the reasons for this was that it was illegal to touch a human corpse except in preparing it for burial or cremation.  This was one of the main reasons Galen's ignorant explanations of the human body were worshiped as the medical Bible for over a thousand years after his death.  This created a roadblock for learning about diseases like asthma and allergies.

This roadblock made it so it was nearly impossible for there to be any major advancements in medicine.  If someone learned something about the human body by dissecting, it was usually done by stealing a corpse from a graveyard, or from a prison, and performed illegally.  And the information learned was kept secret from a monarchy that might kill you, or at least throw you in prison, for learning something that opposed the view of the establishment. So even if something was learned, it was probably never published.  And if it was published, it was so posthumously. 

Thankfully, however, there were a few places scattered around the world where it was legal to perform autopsies.  It was at these places where physicians would flock to obtain medical knowledge, and patients would flock to get the best treatment.  Among the first such place was the great city of Alexandria in Egypt. (1)

Alexander the Great is considered one of the greatest military leaders of all time.  Born in 356 B.C. in Macedonia, a city just north of Greece (Macedonia was not a city-state like Athens and Sparta).  He spent his childhood watching his father, Phillip II, build Greece into a great military power, winning battle after battle. (1)

When he was 13 Aristotle was hired to be his personal tutor.  Like other Greeks, he learned about science, medicine, and philosophy.  (1) Aristotle taught him to read and speak Greek, and taught him to respect philosophy the way the Greeks did.  He loved Greece, it's gods, it's history, and he dreamed of teaching it's culture to people all over the world. (2)

Figure 2 -- A rendering of Ancient Alexandria.  The lighthouse
you see depicted here was one of the seven wonders of the
ancient world.  This was one of the most beautiful cities ever.

His father, Phillip, conquered most of the Greek city-states, and when his father died, Alexander went on to conquer many nations, including Egypt.  As he did in other places he conquered, he championed Greek culture.

As noted by historian John Watson:  "The rapid extension of Grecian arms under Alexander the Great, lead to the diffusion of taste and learning among the surrounding nations.  Pergamus and the new capital of Egypt (Alexandria), became points of scientific attraction second only to Athens; and with the spread of general knowledge, the study of medicine extended to these cities."  (4, page 74)

The Asclepion of Pergamus was surrounded with architecturally amazing structures that "were occupied as places of public instruction and scientific intercourse. Here the orators, sophists, and philosophers of the city held their daily conferences, and sometimes amused themselves in expounding to the sick the vaticinations of the priests. As a school of medicine, the Asclepion of Pergamus enjoyed a long continued celebrity." (4, page 74)

Alexander died in 323 B.C. of a mysterious illness in the palace of Nebuchadrezzar II of Babylon.  He was only one month shy of his 32nd birthday.  At this time the Egyptian portion of Alexander's empire was given to Ptolomy Soter (367-282 B.C.), the brother of Alexander. 

Figure 3 -- The library of Alexandria was one of the largest libraries
in the ancient world.  Physicians came from all over the world
to study here.  Unfortunately it was destroyed by barbarians.
Can you just imagine if this was never destroyed?  Perhaps medical
knowledge would have been advanced faster, and there would be
better asthma and allergy knowledge today, and maybe even better
medicine, or a cure.  If I could go back in time, I'd want to go to the
City of Alexandria during its glory days and peruse ancient writings

Like Alexander, Ptolomy loved arts and sciences, and he formed the great library of Alexandria, and he placed Aristotle in charge of it.  (3, page 33) The flow of knowledge through this city was so abundant its great library "rendered Alexandria the great repository of science and wisdom." Some estimate that by the reign of Ptolomy Philadelphus (36-29 B.C.) the library had accumulated a collection "about two hundred thousand rolls of papyrus, equal to about ten thousand of our modern printed volumes." (4, page 79)

Ptolomy also started Museum of College of Philosophy, or the school of Alexandria, in 331 B.C., which was described best by John Watson in 1856:

It's chief apartment was a lecture room and place of general concourse.  Around the main building, on the outside, was a covered walk or portico.  And connected with it was an Exhedra, in which the philosophers sometimes sat in the open air... This noble institution was originally designed to serve in part as a school for the training of  youth in the higher walks of learning, and in part as a retreat within which men of genius and acquirements, free from the necessary and providing for their daily wants, might have leisure and opportunity, each in his own way, for extending the domain of science, or for increasing the enjoyments of improving the condition of their fellow beings. (4, pages 77-8)

Figure 4 -- Ptolomy

By the time of Ptolomy Philadelphus, the school "had already risen to the highest rank among the Greek schools. (4, page 79)

One of the main reasons for this was that for the first time in the ancient world, dissection was legal in Alexandria.  This was significant, because religion made even touching a human corpse illegal in Ancient Egypt, Greece and Rome.  Now, for the first time in history, the human body could be studied, and it was.  In this way Aristotle was able to describe the insides of the human body by actual dissection. (3, page 33)  

The school was also a place for public lectures and readings, which were very important in Alexandria, as in all ancient civilizations.  This was because books were expensive and few could read.  Great minds would orally educate about the common wisdom of the day, and readers, or orators, would "familiarize" people with the writings of Homer and other great authors of the day. (4, page 82) Watson explained:

Among the Greeks this had been the common mode of enlightening the people, of amusing them, and of molding their opinion.  Most of the poetry, and much of the written history of the nation, were prepared for public recitation.

Placed in charge of medicine at the school were Erasistratus and Herophilus.

Erasistratus (304-250 B.C.) was from the Isle of Chios, and was the grandson of Aristotle.  He was the founder of the school of anatomy at the school of Alexandria, performing many autopsies.  Herophilus (335-280 B.C.) was a native of Chalcedon and was educated at the school of Cos. He also performed many autopsies at the school. (4, page 85) 


Figure 5 -- Aristotle

Along with Aristotle, they both made stunning observations from their inspections of the internals of the human body, and postulated various hypothesis based on these observations.  For instance, Erasistratus discovered that the trachea was a passageway for air (pneuma) to the lungs, and he discovered veins and arteries both originate from the heart.  Only he, like Aristotle,  believed the arteries were filled with air not blood, and hence the name 'arteries.'  And the passage of pneuma from the veins to arteries was the cause of disease(3, page 35-6, 4, page 86))

He disregarded the four humors of Hippocrates and the four elements of Empedocles, and instead postulated that fevers were caused by inflammation.  He was not a believer in purgatives and most medicine, and instead preferred a good diet and gymnastics.  Some believe he was the first to recommend exercise as a means to stay healthy and for healing.  (4, page 86)

Herophilus was among the "first of the Hippocratic school to distinguish himself as an atomist."  He was the first to use the pulse as an "index of varying conditions of health and disease."(4, page 84)

He properly attributed the pulsations of the arteries to the heart. 




Figure 6 -- Herophilus

Of interest is that Herophilus was charged with opening "the bodies of living criminals, to discover the secret springs of life."  (3, page 35)

Unlike Erasistratus, he was a believer in the hypothesis that imbalances of the four humors cause most diseases.  (4, page 85)

He revered Hippocrates to the point that "when obliged to contradict him he always avoided mentioning his name."   Also, unlike his counterpart, he placed a "high value on drugs, which he called, 'the hands of the gods,' and used them in great variety.  (5, page 62-3)

Erasistratus was an empiracist.  Herophilus was a rationalist. In this way, "the same rivalry which existed in Greece between Cos and Cnidos arose also between Alexandria and Pergamus, in which later place Galen was born, and Aesculapius was held in great respect as one of its most celebrated divinities."  (3, page 36-37)

Regardless, anyone who wanted to be a physician in the ancient world was eager to learn at the school of medicine in Alexandria, as "to have studied medicine at Alexandria, was everywhere considered a passport to the confidence and patronage of the public."  (4, page 92)

The school continued "its celebrity as a seat of learning and as a school of medicine, until it was taken by Saracens in 638 of the Christian era."  (3, page 36)

Figure 7 -- 1532 woodcut showing Herophilus (L) and Erasistratus (R)

Alexandria would fall in 619 A.D., and that ended whatever medical wisdom came out of it.  Many of it's wonders were destroyed by barbarians, including it amazing library.  As the library went up in flames, so to did all medical wisdom except for random scrolls scattered here and there.  (6, page 150-2) (7, page 28)

Until the  School of Salerno was established in the 10th century, there were no known autopsies performed, and medicine was left in limbo, or what historians like to refer to as the dark ages of medicine.  (6, page 150-2) (7, page 28)

References:

1. "Alexander the Great Alexander of Macedon Biography: King of Macedonia and Conqueror of the Persian," historyofmacedonia.org, http://www.historyofmacedonia.org/AncientMacedonia/AlexandertheGreat.html
2. "Alexander the Great: Ancient Greece for kids," mrdonn.org, http://greece.mrdonn.org/alexander.html
3. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861,
4. Watson, John, "The medical profession in ancient times," 1856, Baker and Godwin, New York
5. Withington, Edward Theodore, "Medical history from the earliest times,"
6. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
7. The John Hopkins Hospital bulleton," (volume XV 1904), "From the epoch of the Alexandria School (300 B.C.)"

RT Cave Facebook Page
RT Cave on Twitter

400 B.C.: Hippocrates alludes to heart failure

I wanted to make a note here that Hippocrates had no way of knowing about heart failure, or any other diseases of the heart.  So, when the heart caused dyspnea, this would simply be diagnosed as asthma.

However, Hippocrates, and other Greek physicians, did recognize and diagnose as diseases some of the symptoms of heart failure, such as angina (chest pain), dropsy (swelling of the feet and ankles, and hydropsy (fluid in the lungs) and anascara (generalized edema).

In his book "On the Different Parts of Man, Hippocrates said:

Angina arises from blood arrested in the vessels of the neck. (1, page 243)

Here he must have recognized that many people who present with chest pain also have bulging carotid arteries, or the arteries on either side of the neck.   He would have no way of associating this with heart failure.

He continued:

We must bleed in the arm and purge, to divert downward the humours that cause the disease. (1, page 243)

In his book "On Internal Affections," described dropsy, which was the diagnosis when fluid was observed inside the tissue, and he referred to a condition where the fluid caused swelling of various tissues of the body, such as in the feet and ankles, as anascara.

In his book "Predictions and Prognostics," he said that dropsy, like phthisis and epilepsy, are difficult to cure when congenital.  He said: (1, page 129)

For the cure of dropsy, sound viscera and adequate strength, with good digestion, are very essential; good breathing, freedom from pain, equable temperature of the whole body, no emaciation of the limbs, but rather a fulness, although the absence of both is best, with natural softness and size, and the belly soft to the touch. There should be neither cough, thirst, nor dry tongue, whether after sleep, or at other times, as often is the case. The appetite should be good, and after eating no uneasiness. Purgatives should operate promptly, and at other times the stools should be soft and figured. The urine should correspond with the regimen, and with the changes of wines. Labour should be readily supported without feeling fatigued. Such is the best state for an hydropic person, to give the expectation of recovery. In proportion as it deviates therefrom are our hopes to be less sanguine; but they must entirely cease when the reverse of what is above stated is the actual condition; or only be maintained according to the existing state of things.

It is much to be feared that dropsy will succeed large discharges of blood from the stomach and bowels; when connected with fever it will be of a brief character, and few recover. A prediction to this effect may be safely made to the friends of the patient. Large oedematous swellings, disappearing, and recurring again, are more readily cured than in the preceding case. (1, page 129)

Interestingly, he also said:

They are (the symptoms), however  very deceptive, inducing the patient to dismiss his physician, and thus dying without assistance. (1, page 129)

Dropsy of the lung, or fluid in the lung, was treated similar to hydrothorax, with an incision of the chest between ribs to drain fluid from the lung.  (1, page 261)

So he recognized the fact that people suffering from this ailment often did not recognize the symptoms and seek medical attention until it was too late.  This is a common predicament of modern medicine as well.

In "Rationale of Food in Acute Disease: Book IV," he recommends pleurisy, angina and dropsy all be treated with cantharides and other acrids. The patient must also pay close attention to diet, and vomit three times a day for a month. (1, page 221)

In "Semeiotics III: On the Difference of Pulses," Galen said that Hippocrates was the first to use the term "palpitate" as when feeling for a pulse, and "palpitations," as when feeling an abnormal, or rapid beating of the heart. (1, page 602)

The medical profession would not even begin to understand the heart and heart diseases, such as angina and heart failure, until after great minds like Vesalius and Harvey made their great discoveries in the 16th and 17th centuries.

References:

1. Hippocrates, Claudius Galen, writers,  John Redman Coxe, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston

RT Cave Facebook Page
RT Cave on Twitter

400 B.C.: Hippocrates describes pneumothorax

While he didn't understand it nor its cause, Hippocrates described a condition that we now refer to as pleural effusion and he referred to as hydrothorax.  It's a condition where fluid builds up in the pleural cavity.

As a remedy, he described the procedure of paracentesis, which involved creating an incision above the third false rib, and inserting a tube into the opening. He then used a trocar.  A Trocar, according to dictionary.com, is a sharp pointed instrument enclosed in a cannula that was used for withdrawing fluid from the cavity. (1, page 282)

This procedure was very similar to the procedure physicians would perform today for the same ailment. The main difference is that modern physicians would know about aseptic technique and would be better capable of controlling pain.

References:

1. Hippocrates, Claudius Galen, writers,  John Redman Coxe, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston

RT Cave Facebook Page
RT Cave on Twitter

1920-1980: Pneumonia is finally tackled

For most of mankind, deadly diseases like influenza and tuberculosis were the main focus of the medical profession.  It was only when these diseases were tackled were physicians able to focus on other diseases, like pneumonia.

In 1928, Sir Alexander Fleming observed that colonies of the Bacterium Staphylococcus that he was growing in a colony were dissolving.  He later discovered the plates had been infested by a blue-green mold, and he determined it was this mold that was responsible for the bacteria dissolving.  He later grew the mold in its pure form and discovered that it killed many different kinds of bacteria. (5)

The mold he used was Peiciillium notatum.  The importance of this discovery was not known until 1939 when Howard Florey and Ernst Chain isolated the active ingredient and developed a powdered form of it.  (5)

Several Eurpean and American scientists worked together to work on a therapeutic medicine that could be used to treat bacterial infections.

By 1941 they had succeeded, and penicillin studies were performed.  In 1944 antibiotics were made available to treat allied soldiers wounded on the battlefield.

Incidence of pneumonia started to decline in 1937 due to improved medicine. So oxygen therapy, coupled with penicillin, helped decrease the rate of pneumonia deaths.  Yet cases of pneumonia continued to be prevalent.

For example, operations weren't commonly performed in hospitals until the 1950s when effective aneasthetics and breathing machines were made available. These were exciting times among the medical profession, as for the first time in history physicians were able to hone in their surgical skills to the benefit of mankind.

This excitement was stymied somewhat during the 1960s and 1970s when physicians started observing a high incidence of post operative pneumonia, particularly among abdominal surgeries, and despite the use of antibiotics.

Similar observations were made among patients taking large amoungs of sedatives and narcotics.

It was quickly realized that further research needed to be done to determine the cause, and therefore a means of preventing these patients from developing pneumonia.

Studies soon concluded that humans were naturally inclined to action, that when a person was restricted to bed, this resulted in ill health.

That people naturally sigh 3-4 times in an hour in order to exercise the lungs and clear secretions, in an effort to keep the lungs sterile.  Sedatives, and painful surgeries, resulted in patients not taking deep breaths, and this resulted in an increase in the risk for developing pneumonia.

Preventative measures were then established, which mainly included having patients roll over, sit up, stand, and walk as soon as possible after surgery, even if the patients have to push themselves to the pain threshold.

Various devices were then invented with the intent of preventing alveoli from collapsing, and pneumonia from developing.  One device was a blowby device that encouraged patients to blow balls into jars.  Another device was called in incentive spirometer, which encouraged people to inhale and cough.

Morbidity and mortality for post operative pneumonia steadily declined.

Pneumonia in general declined when a pneumonia vaccine hit the market in 1977, and again when a pneumonia vaccine for children hit the market in 2000.

Thanks to all these innovations pneumonia is not the sixths leading cause of death, as opposed to the leading cause of death in the 1930s.

It's true that pneuomonia will continue to inflict people with diminished immune systems, such as the elderly and sick.  Yet with a growing plethera of medical knowledge, physicians have been able to greatly reduce the incidence of this disease, and in the process, prevent many deaths from the malady.

References:

1. "Leading Cause of Death, 1900-1998," http://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf
2. Sturges, Octavius, "The Natural History and Relations of Pneumonia," London, 1876
3. "History of Pneumonia," The British Medical Journal,  Jan. 19, 1952, pages 156-158
4. Schmitt, Steven K., "Oral Therapy for Pneumonia:  Who, When, and With What?" editorial, Journal of Clinical Outcomes Management,  March, 1999, vol 6, No 3, pages 48-50
5. Bellis, Mary, "The History of Penicillin," http://inventors.about.com/od/pstartinventions/a/Penicillin.htm
6. Marrie, Thomas J, "Community Acquired Pneumonia," 2001, New York, chapter one by Jock Murray, "The Captain of Men and Death: The History of Pneumonia."
7. Auld, A.G., "The Pathological Histology of Bronchial Affections," The Lancet, Aug. 6, 1892, page 312
8. Allbutt, Clifford, ed, A System of Medicine, 1909, Toronto, chapter on "Lobar Pneumonia,"  by P.H. Pye-Smith, pages 191-205
9. Addison, Thomas, "A Collection of the published works of Thomas Addison," 1868, 
10. Auld, A.G., "Fibroid Pneumonia," The Lancet,  June 13, 1891, page 1308-1310
11. "Nikolai Fedorovich Gamaleia, The Free Dictionary by Farlex, http://encyclopedia2.thefreedictionary.com/Nikolai+Fedorovich+Gamaleia
12. Osler, William, "The Principles and Practice of Medicine," 1898, 3rd ed., New York
13. *Photo compliments of sciencephotolibrary.com
14. "Plutarch," britannica.com, http://www.britannica.com/EBchecked/topic/465201/Plutarch, accessed 7/20/14
15. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood, pages 84-87 for bronchitis treatment, and 175-177 for emphysema treatment
16. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid

RT Cave Facebook Page
RT Cave on Twitter

760-370 B.C.: Hippocrates redefines medicine

What did Hippocrates really look like. Some historians speculate

most busts of him were made after his lifetime. Prioreschi said:

"It is highly probable that physicians of the Periclean Age wore

their hair and beards as much like the figures of Jove or

Aesculapius as possible, and were otherwise not lacking in the

self sufficiency which characterized the Greeks of the period.

We may therefore infer that the supposed portraits of Hippocrates

are only variants of the busts of Aesculapius. (1, page 92)

There are only a few people in our history whose contributions were so significant they end up being deified. One such man was the great physician Hippocrates.

While he may not have done all the work himself, his name is on one of the first and most significant medical treaties of all time: the Hippocratic Corpus. It would mold the image of Hippocrates, establishing him as the greatest physician of his time and of all time.

The Hipporcratic Corpus, often simply referred to as the Corpus, is a compilation of over 60 medical treaties which are essentially compilations of all the knowledge learned by Hippocrates from his "immediate ancestors," said medical historian Edward Meryon in his 1861 book "A history of medicine." (6, page 22)

The name Hippocrates is a reflection of all the great physicians that formed Greek medicine.  The Corpus is a reflection on the era he was born into.

Pericles (495-429) was in charge of the Athenian
Military during the Pelopannesian War, and
became a leading statesman and orator for Athens. 

Hippocrates was born on the island of Cos, near modern day Turkey, around 460 B.C., during the peek of Athenian democracy, an age when Pericles (495-429) walked the earth as a famous Greek general, statesman, and orator.   (1, page 21-22) (2, page 86)

It was an era of ancient Greece where the citizens of Rome had little work to do, and therefore had plenty of time to read, learn, and think.  This was made possible because most citizens had many slaves who did all the work for them.  This, it is said, gave rise to the Age of Philosophers in ancient Greece.

Of this time in our history, medical historian Fielding Hudson Garrison, in his 1922 book "An introduction to the history of medicine," said:

Never before, or since, had so many men of genius appeared in the same narrow limits of space and time. (2, page 86)

Medical historian Edward Meryon, in his 1861 history of medicine, said:

He lived at the most remarkable epoch of intellectual development, having as contemporaries the philosophers Socrates, Plato, and Xenophon; the statesman Pericles; the historians Herodotus and Thucydides; the poets Pindar, AEschylus, Euripides, Sophocles, and Aristophanes; and last, though not least, the sculptor Phidias. (1 page 22) (also see 8, page 126)

Garrison said Hippocrates was born into an era where the primary role of the physician was "either an associate of priests in times of peace, or a surgeon in times of war."  (9, page 87)

He was also born into an era where medicine was a blend of superstition and mythology, and was esoteric wisdom known only to the priest/ physicians at the Asclepions.  Those who were sick would spend time among the priest/physicians there, and the remedy would be revealed, and often involved magical elements such as incantations and amulets.  Yet these Asclepioins were not hospitals per se, merely places where the sick could learn the healing wisdom from the god Asclepius.

Those who were sick might also summon for a physician, men who, like the priest/physicians, were trained at the Asclepions. Yet these physicians were free from the bonds of the Asclepions, and were able to reach out to the general population, most often visiting their patients at their homes.

Medical historian Max Neuburger said:

From Homer's time (about 800 B.C.) and onward poets and historians make mention of lay physicians who freely exercised their profession untrammeled by temple medicine. In very early times the custom arose for communities to appoint official physicians whose duty it was, for a fixed salary, to to attend the poor gratis, to make the necessary sanitary arrangements in the presence of epidemics, and as experts to give evidence in court: it is equally certain that a medical corp accompanied armies and fleets... and that Greek physicians accepted posts as court and personal medical advisers to foreign princes. (8, page 97)

Natural medicine made it's way into the priesthood at the temple of Cos at an early date, and such medicine was learned by physicians who would then take their medicine outside the temple.  So this provided more options for the sick.  For those who were perplexed by the puerile medicine at the temples, they could summon a physician who practiced natural medicine.

Neuburger said that over time, particularly at Cnidos and Cos, there was a complete separation at the Asclepiades of all temple magic. So the priests and their magic ultimately gave way to physicians and their natural remedies. In the meantime there was a mixture of both types of medicine. (8, page 99)

Once summoned, the physician would then pack his bag of medical supplies and travel to the sick person's home.  Of these medical bags, Neuburger said:

On medical journeys a portable case was taken with indispensable instruments, bandages, ointments, plasters, emetics and purgatives. Such cases have been discovered (8, page 98)

Neuburger said there were also medical homes with sick rooms where the sick could see a physician for temporary treatment, although these homes were mostly reserved for people who required surgical intervention, such as for fractures and open wounds.  (8, pages 97-98)

Since there were no medical treaties at the time, there were no regulations and no standards as to how a physician was instructed. For this reason medical studies varied from one school to the next.

The result was often physicians who were ignorant of their trade, rough with their patients, and painful by their remedies. Many Greeks eventually recovered from their ailments without the guidance of a physician, and therefore it was often suspected that when a physician cured he was merely lucky.

As Hippocrates would later describe, this situation was exacerbated...

...under the pretext that physicians never undertake the care of those, who are already overpowered by disease. They say, that he cheerfully attends on such as would recover without him—but not a step will he take in behalf of those who are most in need of his assistance. If there was an art of medicine, they moreover say, it ought to cure these as well as the former. (3)

So it was no wonder that the sick would prefer to travel long distances to an Asclepion, or stay at home, tucked in their cozy beds, waiting their fate, as opposed to risking a call for any random physician.

Meryon said that most of what is known of the school of Cos, and later about Hippocrates himself, comes from biographies written after the death of Hippocrates.  From these we learn he was the "scion" of a family of physicians at the school of Cos "which had followed the pursuit of medicine at least 300 years." (1, page 21-22)

These physicians were well aware of the poor image of physicians.  They believed this poor image was due to the practice of physicians who graduated from the school of Cnidron.  This school was about 20 miles from Cos, and these physicians didn't care about the poor image, and did little if nothing to improve it.

Medical historian Edward Withington, in his 1894 book "Medical history from its earliest times," said physicians at the school of Cnidron were aggressive with their treatment. He said this is exemplified by the their motto: (4 ,page 52)

"Accurate diagnosis and vigorous treatment."  (4 ,page 52)

Medical historian Max Neuburger said Cnidian physicians focused on diagnosis, and then finding cures for these. He said: (8, page 114)

Their therapeutic methods, in accordance with their ideas upon localisation, appear to have been mostly topical, more radical than expectant and individualising. With knife and cautery to hand they were nothing loth to perform excision of a rib in empyema or nephrotomy in renal abcess and did not hesitate to order excessive purgation, dietetic cures or exhaustive walking exercise. (8, page 115)

Some of their therapeutic methods included: (8, page 115)

• Injection of fluids in the air passages to produce coughing
• Inhalations to promote the expulsion of mucus or pus from the lungs
• Application of leather bags for the purpose of fomentation, swinging movements, etc. (8, page 115)

He wrote about a case described by Caelius Aurelianu in which a prominent physician named Euryphon at the school of Cnidus (a contemporary of Hippocrates) "tries to show that pleurisy is an affection of the substance of the lung."  (4 ,page 52)

Withington said Aurenlianu described the patient as being "thin as a skeleton, his legs like reeds, his chest still full of pus, and his ribs covered with scars from the cautery irons of Euryphon." (4, page 52) 

Neuburger said the writings of Euryphon, all of which have been lost, are believed to have influenced some Hippocratic writings. (8, page 115)

Physicians of Cnidron were also known to take bribes and use poisons to kill the enemies of their patients. To the physicians at Cos, this must have been the culmination of what was wrong with the profession, and what their potential patients must have feared the most.  So their aim was to change this image.  

The physicians at Cos frowned upon the act of using medicine to kill.  They frowned upon the act of being rough with their patients, and using aggressive treatment that was painful, and sometimes killed.  They were very concerned about the image of the profession and they aimed to improve upon it.  They aimed to create a kinder, gentler approach to medicine. This approach is later exemplified by the Hippocratic Treaties "On the Art of Medicine." (3)  

Hippocrates described a family of physicians who impressed upon their students that good bedside manner was essential.  They encouraged the use of gentle hands and gentle remedies. They were encouraged to assess their patient and their surroundings, and to "compare his disease with such as he had previously seen, either the same, or approaching thereto, and which he has cured by the admission of the patient himself." (3)

Like the Cnidian physicians, Con physicians performed accurate assessments, and even accurately described diseases and their treatments.  But the Con were more interested in prognosis than diagnosis, with their cures being based on this prognosis. (8, page 117)

Born into the Con family of physicians was Hippocrates II, a man history knows as the great Hippocrates.

Hippocrates II was the son of Heraclides, and the grandson of Hippocrates. Some historians said he was a direct descendant of Asclepius, and perhaps it was for this reason that Galen (2nd century A.D.) would later say of Hippocrates that "his writings should be reverenced as the voice of a deity." (6, page 21)(also see 5, page 23)(also see 6, page 203-204)

John Watson, in his 1856 book "Medical history from the earliest times," said it was from his father that Hippocrates learned much of his skill, technique and work ethic.  As a child he also had access to the "ablest masters in science and philosophy," and all the best physicians in the world. (5, page 46)(6, page 204)

Watson said that after the death of his father, he traveled to many countries before pursuing his profession in Macedonia, Thrase and other parts of Greece before settling in Thesally where he spent the later portion of his career.  He probably also taught at the School of Cos. In fact, some accounts have him starting the school.  (7, page 46)(8, page 86)

Neuburger said religion prohibited the examination of the internal organs of the human body for the purpose of science.  The only time a person's insides could be examined would be by the wounds obtained during fights in the gymnasium or on the battle field, or during the rare surgery that was performed.  For this reason, Hippocrates must have spent some time in the gymnasia, either as a student or as an observer.  (8, page 150, 156)

Physicians also spent time examining the naked bodies of the men, and so they would have learned, by observation and palpation, what was normal and what was abnormal.  By palpating abdomen's they would have learned what what normal and abnormal abdominal organs, such as the liver and spleen, felt like.  (8, pages 146, 150)

The only other means a physicaians might have learned anatomical knowledge was by dissecting animals, or spending time in slaughter houses or watching sacrifices. (8, page 150)

So, that in mind, it was unlikely Hippocrates observed an autopsy, although highly likely, perhaps with the guidance of his father, that he spent time at slaughtering houses, or observing sacrifices, or observing surgical cases, in order to obtain anatomical knowledge.  It's also highly probable that he spent time in the gymnasium at Cos to observe his father at work, but also to learn about the human body.

Neuburger said:

With regard to the respiratory tract, the Hippocratists knew the trachea, epiglottis and bronchi, and described the lungs as having five lobes... The circulatory system is described in the various writings in a most confused manner.  The starting-point was at first supposed to be the head, later the aorta and vena cave, which were thought to spring from the spleen and liver; according to the book De morbo sacro, all arteries enter the heart.  

He would have learned that the trachea, bronchi, and arteries were hollow and contained air.  He would have learned various bones, joints, bone marrow, and sutures of the skull.  Knowledge of the viscera (heart, liver, stomach, esophagus, intestines, liver, bladder, spleen, and kidney) was "scanty," said Neurburger, although he would have learned what was known about them. (8, page 151)

He would have learned of the nervous system, but sometimes nerves were confused with tendons, said Neuburger.  He would have learned about the four humours, the four qualities, and the four elements, and that their balance was what maintained health, and their imbalance what caused maladies.  (8, page 152)(9, pages 268-270)

He would have learned about a vital principle that was inhaled by the pneuma (breath), and that the "fundamental principle of life is the 'inherent' warmth of the body which has its seat in the left heart. Under the influence of this inherent warmth elementary fluids of the body are formed from food, and from variable admixture of these fluids solid parts of the body are formed." (8, page 152-153)

Organs are "built up" by nutrients obtained from the blood, which was created in the liver, warmed in the left ventricle, and circulated by means of the beating heart through the veins.  Cool air was taken in by the lungs to cool the heart.  (8, page 153)

He learned that the pneuma originated in the heart, or brain, and circulated through the body from one of these organs.  This pneuma would have been responsible for sensation and movement.  The brain may have been responsible for many of the ailments of the body, including diseases of the lungs, colds, catarrh (inflammation), etc. (8, page 153)

Of this, Neuburger wrote:

The brain is, for the most part, looked upon only as a gland, as the seat of cold and phlegm, entrusted with the task of attracting to itself the superfluous water of the body.  (If, in the functions, a disturbance sets in, abnormal accumulations of phlegm occur in other organs, i.e. catarrh.)

When an imbalance of the functions of the body occurs, such as an imbalance of the humours, the brain loses its ability to control the flow of fluids to it, and excessive phlegm flows to one or another organ of the body. For instance, excessive phlegm flowing to the lungs causes asthma, pneumonia, pleurisy, empyema, and phthisis. The same to the nose causes catarrh and coryza.

So through his studies he would have learned the basic anatomical structures of the body, and how they worked together in unity to create life, maintain health, and restore health.  He would have learned how nature assisted in this process.

Thomas Bradford, in his 1898 book "Quiz questions on the history of medicine," said that, at the school of Cos, Hippocrates would have learned from the theories and cures recorded on the stone tablets, or votives, that were stored there.  (5, page 23)

Bradford said he participated in...

"...careful study of the medical records found in the votive offerings that hung in great profusion about the walls of the Aesclepiads.  He soon began to have a reputation as a physician, and his name was known not only in Greece, but in foreign courts also. (5, page 23)

He used the wisdom he learned from his father, at the school of Cos, and from the sages during his travels abroad, to become a very gentle and skillful physician. He would win the hearts of both his patients and his fellow physicians, thus improving the image of the profession, said Withington (4, page 50)

References:

1. Meryon, Edward, "The History of Medicine," Volume I, 1861, London,  (6)
2. Garrison, Fielding Hudson, "An introduction to the history of medicine, 1922, (9)
3. Hippocrates, "The Art of Medicine," Section I, Treaties III, translated by John Redman Coxe, "The writings of Hippocrates and Galen," 1846, Philadelphia, Lindsay and Blakiston (10)
4. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press. (3)  (7)
5. Prioreschi, Plinio, "A history of medicine: Primitive and ancient medicine," v (1)
6. Watson, John, "The Medical Profession from the Earliest Times: an anniversary discourse delivered before the New York Academy of Medicine November 7, 1855," 1856, New York, Baker & Godwin  (4)
7. Sigerist, Henry, "A History of Medicine," volume 2, 1961, Oxford University Press  (2)
8. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
9. Coxe, John Redman, translator, "Hippocrates, the Writings of Hippocrates and Galen," 1846, http://oll.libertyfund.org/titles/1988, accessed 7/6/14, also see the book online at Google books, Philadelphia, Lindsay and Blakiston

RT Cave Facebook Page
RT Cave on Twitter